| NPI | 1457448219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 26047) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 00026047) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2015-01-23 |